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Head:

Do you suffer from any kind of headache ? General or of any particular side the nature of pain, (throbbing/shooting/pulsating/dull/aching )? Any aggravating / ameliorating or triggering cause known, like, exposure to sun or mental exertion or any other cause? Is it better or worse at any time of the day or by walking/ lying down/ pressure/ warmth?

Do you suffer from any affection of scalp, pain/soreness, dandruff, itching, eruptions or falling/premature graying of hair (hereditary or otherwise) etc.? Your nature is mild/ sensitive/ introvert/ extrovert/ domineering/ short tempered/ emotional/ optimistic/ workaholic/ procrastinating/ anxious/ calm etc. Do you like music or any other serious hobbies pursued?

Your memory and mental performance- good/bad, absent minded, forgetful about anything in particular for ex. Of events (distant or recent), names or numbers or faces etc. It would be helpful if you could share some personal information with us about your nature (what others feel about you and what’s your opinion about yourself) and your life especially how do you deal with stress situations in your life? Have you faced any trying or turbulent moments / experiences in the past/ any phases of depression or unnatural behavior? Can you date back any of your complaints to it?

Is there any history of injury to the head?

Face/Mouth/Throat:

Do you wear spectacles or contact lenses? If yes, then nature of the trouble that necessitates their use, for how long, and is any particular eye weaker?

Is the vision deteriorating progressively or is stable? Is there any haziness in the field of vision/ watering/ heaviness/ burning/ redness of the eyes/ glaucoma/ cataract?

Is there any polyp or growth in the nose/ DNS / sinusitis/ allergic rhinitis/sensitivity to smell (of perfumes, cooking food, tobacco, or any other smell)/ loss of smell/blockage of nose (which side)?

What was the treatment taken, from where and what was the result? Have you been using any nasal drops and for how long/ history of surgery for removal of polyp or correction of DNS?

Do you have any disturbance in hearing/ sensitivity to loud/slight/sudden/near/distant noises/ pain in the ear/ blockage of any ear associated with cold or any other complaint?

Have you been using any ear drops and for how long?

Is there any type of discharge or bleeding from eyes/ears/nose/ character (thick, watery, acrid, bland)/ color of discharge/ any other affection of these organs?

Which side of eyes/ears/nose is affected more?

Perspiration:

Which part of the body/ peculiar or offensive odor/staining?

Chest/Respiratory:

Is your cough dry, productive (bringing up mucus), or a combination?

If productive, is the mucus thick or thin, clear, yellow, green, or bloody?

Do you experience chest pain while coughing? If so, where is the pain located? Does it spread to your arm, neck, jaw, or back?

Have you experienced chest pain unrelated to coughing? If so, where was the pain located and did it spread to other areas?

Have you suffered any chest injuries or rib fractures?

Do you have a history of heart disease, high or low blood pressure?

Have you undergone procedures such as angiography, angioplasty, or bypass surgery?

Are you currently taking medications for high blood pressure, water retention (diuretics), or other conditions? If so, which medications, for how long, and what are the results?

Appetite/Digestive/Abdomen:

Diet and Appetite

How many meals do you eat per day? Has your appetite increased or decreased since the onset of your illness?

How much water do you drink daily? How much do you drink at one time? Do you prefer hot, cold, or warm beverages?

What types of food do you enjoy most? Do you have a preference for salty, sweet, spicy, sour, or fried foods?

Do you like or dislike tea, coffee, or milk? Do you prefer them hot or cold? Have you experienced any problems after consuming specific foods? Do you have any unusual cravings or aversions?

Bowel Habits

How often do you have bowel movements? Do you experience more frequent loose stools or constipation?

Are your stools watery, hard, or formed? Do you notice any undigested food particles? Are there any unusual odors or colors?

Do you experience belching (eructation) or gas (flatulence)? Do you find relief after passing gas? Is the gas unpleasant?

Gastrointestinal History

Have you ever had gallstones, jaundice, hepatitis, or appendicitis? If so, please describe the treatment and outcome.

Have you undergone abdominal surgeries such as an appendectomy, laparotomy, or gallbladder removal (cholecystectomy)? Were there any complications from these surgeries? Have the surgical scars healed completely, or do they still cause pain?

Menstrual History:

At what age did you begin menstruating? Have your periods been regular or irregular?

How many days pass between the start of one menstrual period and the next? How many days does your period typically last? Do you experience any discomfort before, during, or after your period? Please describe the color, odor, and amount of menstrual bleeding. Do you experience any clotting?

Do you have any vaginal discharge? If so, when does it occur, and is it related to your menstrual cycle? Please describe the color, odor, consistency, and amount of the discharge. Does it cause itching or discomfort?

How many times have you been pregnant? Were your deliveries vaginal or by cesarean section? Did you experience any difficulties conceiving, during pregnancy, or after childbirth?

Have you ever had a miscarriage or abortion? If so, at what stage of pregnancy did it occur, and what was the reason? Did you experience any symptoms such as nausea, excessive vomiting, swelling, or back pain during any of your pregnancies?

Do you experience urinary tract infections? Do you have any burning sensation when urinating, especially before, during, or after your period? Have you received treatment for urinary tract infections? Have you noticed any unusual color or odor in your urine? Do you urinate more frequently during the day or night? Do you experience accidental leakage of urine, such as when coughing or sleeping?

Male :

Is there any complaint of hydrocele, if yes, which side/ undecided testes/ nightly or involuntary emissions/ painful, incomplete, frequent erections/ impotency or any other complaint.

Is there any tendency for urinary infections or burning before, during or after urination/ treatment taken/ unusual color or odor of urine, if any/ frequency of urination (more in night or day)/ involuntary passage of urine (during cough or sleep or any other time)?

Limbs/ back :

Do you experience any pain in your back or limbs? If so, when did the pain begin? Please describe the type of pain (dull, sharp, shooting, stabbing, or burning). Is the pain worse on one side? Does the pain spread from your back to your limbs or vice versa?

Do you have any shoulder or arm pain? If so, which side is affected, and where does the pain radiate? Please describe the type of pain.

What treatments have you undergone for back or limb pain? How long did the treatment last, and what were the results?

Do you have any unusual posture or gait, such as stooping, hurrying, restlessness, slowness, tremors, jerking, twitching, involuntary shaking, or spinal curvature?

Have you ever broken a bone, dislocated a joint, sprained a ligament, or undergone spinal surgery? Were there any complications from these injuries or surgeries? Have you ever had any foreign objects in your body, such as in your bones, eyes, or heart?

Chest and Respiratory System:

Have you experienced any respiratory problems such as pneumonia, pleurisy, tuberculosis, difficulty breathing, a feeling of suffocation, indigestion (dyspepsia), or wheezing? If so, does the wheezing occur while walking, climbing stairs, lying down, or sitting?

Cough

If you have a cough, is it dry, productive (bringing up mucus), or a combination?

If productive, is the mucus thick or thin, clear, yellow, green, or bloody?

Do you experience chest pain while coughing? If so, where is the pain located? Does it spread to your arm, neck, jaw, or back?

Chest Pain

Have you experienced chest pain unrelated to coughing? If so, where was the pain located and did it spread to other areas?

Have you suffered any chest injuries or rib fractures?

Do you have a history of heart disease, high or low blood pressure?

Have you undergone procedures such as angiography, angioplasty, or bypass surgery?

Are you currently taking medications for high blood pressure, water retention (diuretics), or other conditions? If so, which medications, for how long, and what are the results?

Skin/sleep :

Skin and Nails

How would you describe the texture and overall appearance of your skin? Do you have any rashes, moles, or warts? If so, please describe their location (specific body part), appearance (raised or flat), size, color, number, and whether they itch or bleed. Are there any areas of discoloration or white spots on your body? Do you have any birthmarks?

Are there any changes in your nails, such as discoloration, brittleness, roughness, or white spots? Do your nails become infected or ingrown? Do you bite your nails?

Do you have varicose veins? If so, when did they appear (pregnancy, menopause, etc.)? Are they related to heart, liver, or kidney problems?

Have you experienced any skin conditions such as eczema, psoriasis, or other skin disorders? What treatments have you used, including any topical applications?

Perspiration and Sleep

Do you sweat excessively in any particular area of your body? Does your sweat have a strong or unpleasant odor? Does your sweat stain your clothes?

Is your sleep refreshing or do you feel tired upon waking? Do you prefer to sleep on your back, stomach, or side? How long does it take you to fall asleep? Do you wake up during the night? If so, why (need to urinate, thirst, dreams, difficulty breathing, pain, etc.)? How long does it take to fall back asleep? Do you snore? Do you rely on sleep aids?

Do you have any recurring dreams? Are your dreams pleasant or frightening? Can you remember the details of your dreams?

Modalities :

Triggers, Aggravators, and Ameliorators: Are there any activities, postures, or situations that worsen or improve your symptoms? For example, does lying on a particular side, sitting, standing, walking, climbing stairs, or bending forward make your pain better or worse?

Diet: Are there any foods or drinks that aggravate or improve your symptoms? For example, do you find relief or discomfort after consuming hot or cold foods, ice, ice cream, fried food, spicy food, sweets, sour food, wine, beer, or hard liquor?

Weather: Does your condition change based on the season (winter, summer, rain) or changes in weather (hot to cold, cold to hot)?

Time of Day: Are your symptoms better or worse at certain times of the day (morning, afternoon, evening, twilight, night, before or after midnight)?

Environment: Do you feel better or worse with hot or cold applications, pressure, tight clothing, covering, uncovering, undressing, open air, closed rooms, crowded places, before, after, or during sleep, bathing, menstruation, sexual intercourse, physical or mental exertion, music, sympathy, consolation, before exams, meetings, public performances, or financial or emotional stress?